A stricture is a narrowing of a section of the intestine that causes problems by slowing or blocking the movement of food through the area. Strictures, which are caused by recurrent inflammation, can lead to hospitalization and also to surgery to correct them. This complication is fairly common, with research estimating that more than a third of people with Crohn’s develop strictures within 10 years of disease onset, according to a review published in May 2018 in the World Journal of Gastroenterology. Symptoms of strictures include abdominal pain, cramping, and bloating. In serious cases, strictures can progress to the point of causing a complete intestinal obstruction, which may result in nausea, vomiting, abdominal distention, and severe abdominal pain. It is possible for strictures to occur anywhere along the gastrointestinal tract, but they are most often found in the last part of the small intestine and in the colon. “Between 70 and 90 percent of people with Crohn’s disease will require surgery after 5 to 10 years,” says Anita K. Gregory, MD, the director of the colorectal program at St. Joseph Hospital in Orange, California, and a former member of the medical advisory committee for the Orange County chapter of the Crohn’s & Colitis Foundation. “Of those requiring surgery, 50 percent are due to strictures.” There are three options available to treat strictures, says Bo Shen, MD, a gastroenterologist at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center in New York City:
Medical therapy with steroids, immunosuppressive agents, or anti-inflammatory agentsEndoscopic therapy (balloon dilation, endoscopic needle knife, or insulated tip knife therapy to open up the stricture)Bowel resection and anastomosis, or strictureplasty
Though surgery is the most effective treatment, followed by endoscopy and then medical therapy, the degree of invasiveness and risk for complications also follow in that order, according to Dr. Shen. “Strictureplasty evolved as a surgical procedure designed to preserve intestinal length,” says Dr. Gregory. “It is appropriate for diffuse multiple strictures, patients with previous resections of more than 100 centimeters of small intestine, and those with short bowel syndrome.” Endoscopic balloon dilation is technically successful in 75 to 90 percent of cases, Gregory says. According to the World Journal of Gastroenterology review, the procedure has been found to be safe and effective as a first line of treatment for people with Crohn’s. Serious complications are rare and occur in only 3 percent of cases, the researchers report. According to an article published in January 2016 in the United European Gastroenterology Journal, of the 46 patients with Crohn’s who received balloon dilation, 83 percent were satisfied with the outcome. While living with Crohn’s complications can be very difficult, it is likely that periods of disease flares, when symptoms are worse, will be followed by times of remission, when these symptoms are less noticeable or maybe even nonexistent. And while perhaps not permanent or perfect, treatment options that can make life a little bit easier certainly do exist. Additional reporting by Ashley Welch.
